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Dr. Stoate: My right hon. Friend has told the House how many more hip and knee replacements were carried out on the NHS last year. Will he tell me what would have been the increased burden on an average family, especially a pensioner family, had those treatments been carried out in the private sector with private insurance?
Mr. Milburn: I was coming to precisely that point. I think that the average cost of a hip replacement on the NHS is about £5,000, and that of a cataract operation is about £2,000. Those are NHS costs, and the NHS is cheaper than the private sector.
My hon. Friend makes an extremely good point. To an overwhelming extent, cataract operations and hip and knee replacements are the operations of old age. Why, on 16 January, did the hon. Member for Woodspring tell The Sunday Times that private medical insurance companies should cover conditions such as
hip and knee replacements, hernia and cataract operations
8 Mar 2000 : Column 1026
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leaving the NHS to do other things? It was not a slip of the tongue: later that month, on "Sky News", the hon. Member for Runnymede and Weybridge (Mr. Hammond) made it absolutely clear that, under Conservative plans, people would look to the NHS
when they had serious life-threatening conditions and would look to their private insurance to help them
There is no ambiguity and no weasel words--the message could not be clearer. Conservative policy is to reduce the NHS to a core service for life-threatening conditions, thereby leaving other conditions--such as hip and knee replacements and hernia and cataract operations--to the private sector. Surely, there can be no greater distortion of clinical priorities than the Conservatives writing off the 300,000 people--many of them pensioners--who rely on those operations every year. Pensioners are the people who most need health care and can least afford private health insurance. The Conservatives' policies amount to no more and no less than a new Tory tax on old age.
Dr. Fox:
The right hon. Gentleman should read more than a few misquoted columns in The Sunday Times. Had he read this week's newspapers, he would know that I stated explicitly last week that, for many reasons, a core model NHS could not work in the United Kingdom. However, does he accept that if we do not have a core model, any rationing in the NHS has to be done by means of waiting times and proper prioritisation of cases? Does he also accept that if people were encouraged to take out greater private coverage, either individually or through their employer, it would reduce pressure on the NHS and produce an expansion of total health care, which would help to achieve the outcomes that everyone wants?
Mr. Milburn:
The last time the hon. Gentleman and I had exchanges about The Sunday Times article, he said that he was going to write to the newspaper to demand a retraction.
Mr. Milburn:
Yes he did--it is in the Official Report. Has he written that letter or not? If he has not, I can only assume that the article was an accurate reflection of what he told The Sunday Times about Conservative party policy.
Mr. Milburn:
If it is ridiculous, the hon. Gentleman should send The Sunday Times a letter demanding a retraction two months after the publication of the article in question. In fact, he knows that I am telling the truth--that is the Conservatives' policy.
If individuals want to take out private health insurance, that is a matter for them, but the idea that that could be a panacea for our health care system is fatuous. There is no army of unemployed oncologists--or, according to Sir George Alberti, unemployed cardiologists or cardiac surgeons--waiting for the private call to arms.
An expansion of the private sector must inevitably mean a contraction of the public sector. We have been down that route. We tried that model of care during the 1990s.
The then Conservative Government spent £150 million a year subsidising old people to take out private medical insurance. It did not make a jot of difference to the numbers taking out private health insurance. The idea that that somehow acts as a safety valve for the national health service is simply wrong and fatuous.
Mr. Desmond Swayne (New Forest, West):
Will the Secretary of State give way?
Mr. Milburn:
No, I am not giving way.
The contrast could not be clearer. Yes, the NHS needs modernising, which is what the Government are doing, but no, the NHS does not need privatising, which is what the Conservatives propose to do. Conservative health policy would indeed distort clinical priorities and mean financial under-provision for the NHS.
No one pretends that everything in the garden is rosy. It is not, but step by step we are making the NHS better. It takes time, but we are making real progress. The country and the service will recognise that. There are more doctors, treating more patients in the NHS; more nurses, training and working in the NHS; new hospitals beginning to be completed for the NHS; modern casualty units coming on-stream throughout the NHS; and fewer in-patients waiting and more out-patients being treated.
Mr. Nick Harvey (North Devon):
I congratulate the hon. Member for Woodspring (Dr. Fox) on securing an opportunity for another debate in the House about health care provision. I agreed with a number of the points that he made. As he explained, the arbitrary waiting list initiative and the targets that were set have in many instances distorted clinical priorities, despite the protestations to the contrary from the Government Front Bench.
Anyone who visits hospitals and speaks to representatives of the professional organisations in the NHS knows that every time hospital managers are called upon to make decisions and set priorities, they are not making the decisions or setting the targets that they would otherwise have done, because they have to meet the waiting list targets.
Mr. Geraint Davies:
The hon. Gentleman makes much of priorities, but is he aware that the National Audit Office found that last year the NHS performed an extra half a million operations? Will he give a big clap to the NHS, irrespective of priorities, for the fact that the overall amount of treatment is escalating rapidly, and we are committed to keep it going up?
Mr. Harvey:
I congratulate NHS staff on achieving the objective of performing more operations. It is entirely
In its 1997 general election manifesto promise, the Labour party stated:
That was a sensible and laudable aim, but, despite the fact that extra money has gone into the health service--a matter to which I shall return--it was clear that demand would continue to rise over time. It always does. If the Government did not anticipate that the number of people needing those extra operations would rise, it was extremely shortsighted of them to frame the policy commitment in that way. The hon. Member for Woodspring was right to say that, from the outset, warnings were given about that. In the Liberal Democrat manifesto our policy commitment was measured on the length of time that people had to wait, not on the number of people on the waiting list.
The number of other people on the list is of relatively little interest to people who are in the unfortunate position of waiting for an operation. They want to know for how long they will have to wait. It would have been more sensible of the Government to set themselves targets on the length of time that people have to wait. People are having to wait longer.
I am slightly puzzled by the Opposition's political objectives in choosing the subject of this afternoon's debate. They have made some important, serious points, but none are new. The ground has been fairly well covered. If the hon. Member for Woodspring hoped to secure news coverage, he would have aroused more news interest if he had told us more about the Conservative policies that he was distilling, and especially the role that he envisages for the private sector. I suspect that more journalists would have been in the Gallery, waiting to hear that. We await more information with interest.
In the rush to get people off in-patient waiting lists, the number of people on out-patient lists has increased. It has more or less doubled since the election from 250,000 to more than 500,000. Although a small downturn occurred recently, the number of people on those lists has increased massively. That more than compensates for the Government's limited progress on the objectives that they set themselves of trying to reduce in-patient waiting lists.
The Secretary of State made a fair point in his speech when he said that we should not be too carried away by figures that appear over a couple of months, especially if they cover the mid-winter period, because authorities and trusts will set different short-term priorities to cope with winter pressures. He is right. However, the overall trend has been upwards for the number of people who wait for unacceptable lengths of time.
It is interesting to consider regional variations. In the south-west--my region--there has been an overall increase in NHS in-patient lists, never mind out-patient waiting lists, since the general election. In the last quarter of last year, 159,000 patients waited more than 26 weeks for an appointment with a consultant after a written
referral by their general practitioner, compared with 149,000 in the previous quarter. Even before the Christmas problems and the winter worries, matters were deteriorating.
It should be no surprise that the winter pressures caused such havoc in the health services. Despite promises, and the analysis made in the Labour party manifesto commitment that I quoted, the vast, generous allocation of funding that the Secretary of State describes is not being made to the health service. In a Liberal Democrat Opposition Supply day debate, I said that the Government's methods of accounting are, to put it mildly, unusual.
Those methods have never been used previously, in other walks of life or in other countries. However, as a doctor put it to me, "If my child grows 3 inches in the first year, 3 inches in the second year and 3 inches in the third year, surely the child has grown 9 inches, but under the Government's accounting methods, the child has grown 18 inches." That is the truth about the £18 billion that has gone into the NHS.
I listened with interest to the hon. Member for Woodspring, who, assisted by interventions from his colleagues, went through some of the difficulties that the health service faces. He referred to those that the NHS Confederation had mentioned, and explained how they wiped out some of the money that appears to have been put into the health service. The hon. Gentleman was right to say that several important points needed to be made, not least on pay awards and the costs of coping with improved working rights and conditions, among others, that managers have to tackle. However, as he went through the list and as Conservative Members referred to the difficulties that those issues cause, I could not help but think back to the number of delegations of which I was a member during the previous Parliament that pressed Ministers for more funds on behalf of local education authorities, local councils and health authorities.
In those presentations, we invariably said to the Conservative Ministers facing us, "Look at the terrible pressures that the authority will face, not least funding pay rises." Unfortunately, I do not recall the provision of more cash ever being part of the response. I recall their saying, "These are simply the facts of life and local education authorities and the like are no different from businesses. Everybody has to face those additional costs." Although I very much agree with what the Conservatives have said today, on that particular aspect there seems to be a marked distinction between what they are saying in opposition and what I recall even the kindliest Conservative Minister saying in government when one petitioned for more cash.
The Secretary of State made the point that part of Government policy has been to set about a modernisation programme. In general terms that must be right and, indeed, in some specific terms it has headed in the right direction. We have detailed points of dispute with them over a number of changes, but their reforms of primary care, the introduction of the National Institute for Clinical Excellence and the Commission for Health Improvement, and the development of national service frameworks are all sensible policies that move in the right direction. However, the danger is that they will convince themselves that modernisation is in some sense an alternative to putting additional funding into the national health service. The reality is probably the reverse.
If the modernisation policy works as well as I hope it will, it will result in an improving NHS that will probably cost even more to run. I remember the Conservative Government setting about the process of introducing care in the community. The only thing that was wrong with what otherwise seemed to be an entirely laudable policy objective was the belief that it would somehow cost less. Anybody could see that closing down those appalling old mental asylums and putting people into care in the community was entirely right, but it was a banking certainty to cost a lot more money. We have found precisely that in practice.
For the first two years of this Parliament, the Government decided to saddle themselves with the spending objectives left in place by the previous Conservative Administration. Only in the last three, under the comprehensive spending review, have they started to load significant sums into public services. The result will be that, by the end of this Parliament, they will struggle to convince the electorate that they have expanded health service funding by any more than their Conservative predecessors. Were the election to be called next spring, which seems to be a fashionable bet in some quarters, they would have had only a four-year Parliament of two lean and two slightly better funded years. They would not even have achieved a real-terms increase year on year as great as that managed by the previous Conservative Government.
Unless the Government take radical action pretty quickly, they will face the electorate in May next year having to explain why their increases in health service spending have not even kept up with those of the Conservatives. With the Budget only three weeks away and the comprehensive spending review to be published in July, I can only hope that they find extra money that goes some way to meeting the objective--which the Prime Minister seemed to come up with on the hoof a few weeks ago--of trying to achieve average European Union health spending within five years.
The Conservatives have cut Government spending . . . by the equivalent of more than £3 billion as spending on the bills of economic and social failure has risen. We are committed to reversing this trend of spending. Over the course of a five-year Parliament, as we cut the costs of economic and social failure we will raise the proportion of national income"
that is spent on health.
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